2023-02-13T11:46:04-06:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2021-07-01 760139802 ST DOMINIC VILLAGE STDO 7137418701 2401 HOLCOMBE BOULEVARD HOUSTON TX 77021 GRADY MULLINS CFO 7137418701 2023-02-08 1 GRADY MULLINS 999009999 JEFF PARKER P00970069 6182331200 2023-02-08 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z AMY SHIELDS 2401 HOLCOMBE BOULEVARD HOUSTON TX 77021 14781856 0 0928 X WWW.STDOMINICVILLAGE.ORG X 1998 TX CARING FOR OUR ELDERS WITH THE COMPASSION OF CHRIST BY HONORING OUR BELIEF IN THE DIGNITY OF LIFE AND SERVING A COMPASSIONATE COMMUNITY. 16 16 161 50 0 0 3215285 1378454 12472037 12618023 32748 29604 1273694 684547 16993764 14710628 0 0 0 0 6837092 6710072 0 0 575871 8954274 9615312 15791366 16325384 1202398 -1614756 15129243 13513269 5255348 5308376 9873895 8204893 X CARING FOR OUR ELDERS WITH THE COMPASSION OF CHRIST. 0 0 9617892 0 8791837 SKILLED NURSING FACILITY (SNF) - OUR REHABILITATION AND NURSING CENTER OFFERS BOTH SHORT TERM (SNF) AND LONG TERM SERVICES. WE HAVE MEDICARE AND MEDICAID CERTIFIED BEDS IN ADDITION TO ACCEPTING PRIVATE PAY AND HOSPICE RESIDENTS. 2032370 0 1857815 INDEPENDENT LIVING - OUR INDEPENDENT LIVING FACILITY HAS 120 ROOMS AVAILABLE ON A PRIVATE PAY BASIS ONLY. WE HAVE THREE LOCATIONS TO CHOOSE FROM FOR OUR INDEPENDENT ROOMS - CHARLOTTE HALL, DOROTHY HALL AND THE TOWER. 1473021 0 1346507 ASSISTED LIVING - OUR ASSISTED LIVING FACILITY HAS 48 ROOMS AVAILABLE ON A PRIVATE PAY BASIS ONLY. THE ROOMS ARE LOCATED IN THE TOP THREE FLOORS OF THE TOWER. THERE IS A FULL TIME NURSING STAFF THERE TO ASSIST THE RESIDENTS IN THIS FACILITY. 564639 0 516144 PRIEST RETIREMENT HOME - OUR PRIEST RETIREMENT FACILITY HAS 24 ROOMS AVAILABLE FOR RETIRED PRIESTS. WE HAVE A COOK THAT PREPARES ALL OF THEIR MEALS AND A DEACON THAT ASSISTS WITH OVERSIGHT OF THE PRIEST RETIREMENT HOME. 115654 0 105720 WARREN CHAPEL - THE WARREN CHAPEL IS LOCATED ON OUR CAMPUS AND OFFERS A PLACE OF WORSHIP FOR BOTH CATHOLICS AND OTHER DENOMINATIONS THAT LIVE HERE AT ST. DOMINIC VILLAGE. THE DAILY AND WEEKEND MASSES ARE OPEN TO THE PUBLIC. 680293 0 621864 13803576 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 76 0 161 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X GRADY MULLINS 7137418701 2401 HOLCOMBE BLVD HOUSTON TX 77021 MICHELE MALLOY CHAIR 0.50 0.00 X X 0 0 0 DR REED YOUNG BOARD MEMBER 0.50 0.00 X 0 0 0 HIS EMINENCE DANIEL CARDINAL DINARD STL, ARCHBISHOP OF GALVESTON 0.50 0.00 X 0 0 0 DEIDRA SMITH SECRETARY 0.50 0.00 X X 0 0 0 AAD DE LANGE BOARD MEMBER 0.50 40.00 X 0 208725 27866 SR DONNA POLLARD BOARD MEMBER 0.50 0.00 X 0 0 0 JAMES J DAVIS BOARD MEMBER 0.50 0.00 X 0 0 0 JUDITH RAINES BOARD MEMBER 0.50 0.00 X 0 0 0 FAITH SEPE BOARD MEMBER 0.50 0.00 X 0 0 0 MARGARET MCCONN BOARD MEMBER 0.50 0.00 X 0 0 0 JORGE GUZMAN BOARD MEMBER 0.50 0.00 X 0 0 0 BISHOP ITALA DELLORO BOARD MEMBER 0.50 0.00 X 0 0 0 LOUIS PELTZ BOARD MEMBER 0.50 0.00 X 0 0 0 HUGH IDSTEIN BOARD MEMBER 0.50 0.00 X 0 0 0 RICHARD BROOKS BOARD MEMBER 0.50 0.00 X 0 0 0 POLDI TSCHIRCH BOARD MEMBER 0.50 0.00 X 0 0 0 AMY SHIELDS CEO 40.00 0.00 X 190845 0 2600 GRADY MULLINS CFO 40.00 0.00 X 134929 0 9828 ROBBIE BRADFORD DIRECTOR OF NURSING 40.00 0.00 X 124827 0 7923 450601 208725 48217 3 0 1 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 DIETARY AND JANITORIAL 2146979 REHABCARE PO BOX 503534 ST LOUIS MO 60680 THERAPY 995805 DE HARVEY BUILDERS 3663 BRIARPARK SUITE 101 HOUSTON TX 77042 CONSTRUCTION 856519 TWOMAGNETS INC 340 S LEMON AVE 5028 WALNUT CA 91789 STAFFING AGENCY 671401 AIM STAFFING INC 9900 WESTPARK DR HOUSTON TX 77063 STAFFING AGENCY 347385 9 30000 243882 106789 997783 1378454 PROGRAM SERVICE FEES 623000 12618023 12618023 12618023 29604 29604 259711 30000 71228 188483 188483 MANAGEMENT SERVICES REVENUE 623990 453729 453729 OTHER REVENUE 623990 42335 42335 496064 14710628 12618023 0 714151 X 338203 315962 22241 5334212 4426308 517818 390086 147575 101421 39557 6597 467145 391453 50540 25152 422937 338951 55549 28437 37513 37513 4666854 4408550 247060 11244 49787 2255 8853 38679 997231 946785 43878 6568 1002091 851727 136369 13995 16300 3509 3050 9741 46501 90 45936 475 202876 81150 121726 655797 620330 35467 260621 233305 27316 REPAIRS AND MAINTENANCE 776054 690932 85122 BAD DEBT 675423 675423 RECOGNITION EVENTS 142727 27981 92287 22459 FACILITY LICENSES AND B 85537 3406 81934 197 16325384 13803576 1945937 575871 3005604 1387450 613221 26754 747935 926197 29300827 18513247 10316355 10787580 446128 385288 15129243 13513269 953693 1231080 38662 20021 4247847 4057150 15146 125 5255348 5308376 X 8118166 7085447 1755729 1119446 9873895 8204893 15129243 13513269 -1614756 -54246 0 X X 0 1 X 1 0 X 1764369 1102301 2268145 3215285 1378454 9728554 15867091 15278403 14712148 12472037 12618023 70947702 61862 66725 23501 246411 259711 658210 17693322 16447429 17003794 15933733 14256188 81334466 0 0 0 81334466 12425 20280 15019 32748 29604 110076 12425 20280 15019 32748 29604 110076 47910 528114 498613 509606 496064 2080307 17753657 16995823 17517426 16476087 14781856 83524849 0.97380 0.98010 0.00130 0.00130 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2017 AMOUNT: $ 47,910. 2018 AMOUNT: $ 57,920. 2019 AMOUNT: $ 86,340. 2020 AMOUNT: $ 66,771. 2021 AMOUNT: $ 42,335. MANAGEMENT SERVICE FEE - 2018 AMOUNT: $ 470,194. 2019 AMOUNT: $ 412,273. 2020 AMOUNT: $ 442,835. 2021 AMOUNT: $ 453,729. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 446128 -46465 14375 385288 372606 86589 13067 446128 347927 7500 26629 9450 372606 314060 9125 24742 347927 254146 42388 17526 314060 0.62528 0.25226 0.12246 0 1 1 1362314 1362314 19049924 12383258 6666666 4262813 2812226 1450587 3534644 3317763 216881 1091132 1091132 10787580 ACCOUNTS PAYABLE TO THE ARCHDIOCESE 125 125 X 14727610 -54246 71228 16982 14710628 0 14710628 16396612 71228 71228 16325384 0 16325384 PART IV, LINE 2B: THE ORGANIZATION HOLDS RESIDENT FUNDS IN A CUSTODIAL / TRUST ACCOUNT RECORDED ON ITS BALANCE SHEET. THOSE FUNDS ARE USED FOR THE BENEFIT OF EACH RESPECTIVE RESIDENT AS NEEDED. PART V, LINE 4: FUTURE USE FOR ST. DOMINIC VILLAGE PART X, LINE 2: SDV'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. SDV IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS EXEMPT STATUS. SDV IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT DONOR BENEFIT COSTS 71,228. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT DONOR BENEFIT COSTS 71,228. BISHOP RIZZOTO GOLF CLASSIC 110826 0 110826 33039 4000 EVENING WITH THE BISHOPS 155269 30000 125269 20284 13905 266095 30000 236095 53323 17905 71228 164867 X X 0 0 0 0 0 0 0 0 0 AAD DE LANGE BOARD MEMBER 0 208425 0 300 0 0 0 15609 0 12257 0 236591 0 0 AMY SHIELDS CEO 170888 0 19957 0 0 0 2600 0 0 0 193445 0 0 0 PART I, LINE 7 THE ORGANIZATION PAID PERFORMANCE BASED BONUSES. FORM 990, PART VI, SECTION A, LINE 1A THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE CEO, THE OFFICERS OF THE BOARD OF DIRECTORS, AND THE CHAIR OF EACH COMMITTEE OF THE BOARD OF DIRECTORS. THE SPECIFIC DUTIES OF THE EXECUTIVE COMMITTEE INCLUDE, BUT ARE NOT LIMITED TO (I) RECOMMEND THE AGENDA FOR MEETINGS OF THE BOARD OF DIRECTORS; (II) COORDINATE THE WORK OF OTHER COMMITTEES, STAYING INFORMED ON PROPOSALS BEING PREPARED BY COMMITTEES AND WORKING WITH COMMITTEE CHAIRS TO SCHEDULE AND REVIEW PROPOSALS PRIOR TO PRESENTATION TO THE FULL BOARD OF DIRECTORS; (III) APPOINT CHAIRS OF STANDING AND AD HOC COMMITTEES; (IV) APPROVE POLICIES FOR OVERSIGHT AND GOVERNANCE OF THE ORGANIZATION; (V) OVERSEE MANAGEMENT OF COMMITTEES; (VI) REVIEW THE PERFORMANCE OF THE EXECUTIVE DIRECTOR ANNUALLY AND REPORT THE PERFORMANCE SUMMARY TO THE SOLE MEMBER; AND (VII) RECOMMEND TO THE BOARD OF DIRECTORS THE ANNUAL OPERATING BUDGET, STRATEGIC PLANS AND MAJOR FUNDRAISING ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ST. DOMINIC VILLAGE IS THE BISHOP OF THE ARCHDIOCESE OF GALVESTON-HOUSTON. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS ARE APPOINTED BY THE ARCHDIOCESE OF GALVESTON-HOUSTON'S SELECTION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE FOLLOWING RIGHTS AND RESPONSIBILITIES. (I) REMOVE ANY DIRECTOR, WITH OR WITHOUT CAUSE, AT ANY TIME; (II) APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS; (III) APPROVE THE INCURRENCE OF INDEBTEDNESS IN EXCESS OF $10,000 IN ANY ONE TRANSACTION, THE GRANTING OF ANY MORTGAGE OR SECURITY INTEREST IN PROPERTY TO SECURE INDEBTEDNESS, OR THE SALE, LEASE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE ORGANIZATION'S ASSETS; AND (IV) THE POWER TO HIRE AND DISMISS THE EXECUTIVE DIRECTOR, IN CONNECTION WITH WHICH THE MEMBER MAY APPOINT A COMMITTEE TO ASSIST IN THE SEARCH FOR AN EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED BY THE FINANCE COMMITTEE AND THE CFO FOR ST. DOMINIC VILLAGE WILL LEAD THE DISCUSSION WITH THE FINANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. EACH BOARD MEMBER IS REQUIRED TO DISCLOSE ANY CONFLICTS. IF A CONFLICT IS BROUGHT TO THE BOARD'S ATTENTION OR IT BECOMES AWARE OF A POTENTIAL CONFLICT, THE BOARD MEMBER MUST REMOVE HIMSELF/HERSELF FROM THE MEETING WHILE INDEPENDENT BOARD MEMBERS VOTE ON THE TRANSACTION OR ARRANGEMENT. THE DISINTERESTED BOARD MEMBERS DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15 ST. DOMINIC VILLAGE'S BOARD OF DIRECTORS REVIEWS AND APPROVES THE CEO'S COMPENSATION. MANAGEMENT UTILIZES THE HOSPITAL AND HEALTHCARE COMPENSATION SURVEY TO ASSIST IN REVIEWING THE SALARIES OF OTHER MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 ST. DOMINIC VILLAGE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 4,408,550. MANAGEMENT AND GENERAL EXPENSES 247,060. FUNDRAISING EXPENSES 11,244. TOTAL EXPENSES 4,666,854. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCESS IS CONSISTENT WITH PRIOR YEARS. ARCHDIOCESE OF GALVESTON-HOUSTON 1700 SAN JACINTO HOUSTON TX 77002 746018777 RELIGIOUS TX 501(C)(3) LINE 1 N/A 0 0 0 1 0 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0